When does a problem become a “crisis”? Is health care in the Virgin Islands a problem, or does the territory face a health care crisis?

Not a simple question. There usually isn’t a bright line between problem and crisis, but you could make the point that you have a crisis when it’s no longer possible to avoid action. Crisis or not, building healthy communities will help improve Virgin Islanders’ quality of life and reduce health care costs for residents and government agencies alike.

The term “crisis” is often linked to health care. Recently, Source stories have included the problems facing the territory’s two hospitals, and Scott Johnson has provided in-depth analysis of the territory’s pressing health insurance challenges, in a lengthy letter to the Source. (See Related Link below)

These are significant problems. But are they the fundamental problem? The answer to that question is “no.” The fundamental problem is that we are a nation with large numbers of unhealthy people, living in what are unhealthy communities. And the Virgin Islands is no exception.

In our country, “health care” is increasingly confused with “health insurance.” If you look at what passes for debate in Congress, it is all about “health insurance.” And, finally, this often-harebrained discussion has brought the big health care question to the surface. That question: is access to health care a “right,” or is health care just another “product”? If you can afford it, good. If not, tough.

The Republican leaders now have an answer to that question: it is just another product. Access to health care services is not a right or an “entitlement.” And they have strong support for this view from their “base,” people who don’t want their tax dollars going to pay for someone else’s health care, especially if that someone else is one of “the others.”

This position has major implications for the Virgin Islands, whose population consists mostly of “the others.” The focus on insurance and hospitals crowds out discussion of other important issues, such as primary care, mental health and dental care. But, most important, it ignores what is the biggest issue of all: unhealthy people. And, here again, the Virgin Islands is as American as apple pie; actually, as American as apple pie a la mode, two Big-Macs, fries and a 40-ounce Coke.

Big ideas in the United States almost invariably move from west to east. In the western United States, California in particular, the issues mentioned above are all discussed. But there is a far bigger theme. It is that there will never be enough money to treat illness, especially chronic “lifestyle” illnesses, in what are defined as socially vulnerable communities. Conclusion: the focus in the future must be on building healthy communities with healthy people and reducing the need for “health care.”

When you combine existing social vulnerability with emerging political and government trends in the age of Trump, the likelihood of a deepening health care crisis grows by the day. This is particularly true in vulnerable communities, of which there are any number on St. Croix and St. Thomas.

Given these realities, what can be done to create “healthy communities”?

Start with most basic qualities. Healthy communities are places where people work, socialize and play together. They have ways to focus on what is most important and to set clear priorities. They have local government that sets policies that support healthy living. Among the most important of these: solid nutrition, physical activity, learning, proximity to health services, dramatic reductions in violence, and support for big reductions in drug, alcohol and tobacco use.

None of this is easy, but, on the other hand, none of it is expensive, and the benefits in wellbeing and happiness are enormous. It is mostly “bottom-up” stuff. There are lots of places to start, for example, community walking groups, a focus on physical activity and healthy living in schools, community gardens, replacing junk food with fruits, and sports teams and activities for all age groups.

If you look at the Virgin Islands, there are plenty of “green shoots. ” They need to be multiplied and replicated, with a strong emphasis on community building and community peace.

It is a big challenge. But that challenge is a lot smaller and far less expensive than fixing and sustaining two hospitals, along with other health care facilities in the face of the political, demographic and climate tsunami that is either here or on the way.

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Thanks for an interesting article Mr. Schneiger. I would appreciate hearing your thoughts on multiplication and replication of the “green shoots”, particularly in the context of our apparent propensity to focus solutions towards small groups, the potential to create synergies between initiatives, and the requirements for sustaining community action.

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